BCBSNC Exceeds Affordable Care Act’s Medical Loss Ratio Requirement in 2011

MLR Ratio
CHAPEL HILL, N.C. – As health insurers across North Carolina and the nation prepare to distribute medical loss ratio (MLR) rebates to customers, Blue Cross and Blue Shield of North Carolina (BCBSNC) is notifying customers that it exceeded the federal requirement for health care spending and is therefore not issuing rebates to customers.
 
The 2011 MLR rule for North Carolina required that spending on health care services and improving health care quality be at least 75 percent of premium revenues for individuals, 80 percent for small groups and 85 percent for large groups.  Insurers who fail to meet those requirements must issue the difference in the form of rebates.  Unlike some insurers, BCBSNC MLRs exceeded these requirements at 85 percent for individual, 85.5 percent for small groups and 89.5 percent for large groups.
 
“The fact that we exceeded the federal requirement for health care spending in 2011 means that we spend at least an extra $230 million on our customer’s health care than our competitors who are issuing rebates,” BCBSNC President and CEO Brad Wilson said. “BCBSNC continues to lead the way in improving access to quality health care and better health outcomes for our customers.”
 
During 2011, BCBSNC spent 85 cents per premium dollar on the medical care of its customers. Most of the remainder of the premium dollar went toward customer service and information technology. BCBSNC had a net income ratio (profit margin) of 3.2 percent for 2011, equating to just 3.2 cents for each dollar of revenue. 
 
In early July BCBSNC will begin mailing notices about meeting the federal requirement to customers who had coverage with BCBSNC during 2011.


About BCBSNC:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.6 million members, including approximately 900,000 served on behalf of other Blue Plans. For 78 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina was named one of the World’s Most Ethical Companies by Ethisphere Institute in 2012. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com.
 
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